Pseudomonas aeruginosa antibiotic susceptibility profiles, genomic epidemiology and resistance mechanisms: a nation-wide five-year time lapse analysis
Authors: Miquel Àngel Sastre-Femenia, Almudena Fernández-Muñoz, María Antonia Gomis-Font, Biel Taltavull, Carla López-Causapé, Jorge Arca-Suárez, Luis Martínez-Martínez, Rafael Cantón, Nieves Larrosa, Jesús Oteo-Iglesias, Laura Zamorano, Antonio Oliver, Fátima Galán-Sánchez, Irene Gracia-Ahufinger, Luis Martínez-Martínez, Carmen Liébana-Martos, Carolina Roldán, Juan Manuel Sánchez-Calvo, Encarnación Clavijo, Laura Mora-Navas, Javier Aznar, José Antonio Lepe, Ángel Rodríguez-Villodres, Esther Recacha, Francisco Javier Casas-Círia, Carmen Martínez-Rubio, Marco Antonio Sempere-Alcocer, Lina Martín-Hita, Cristina Seral, Ana Isabel López-Calleja, Carmen Aspiroz, Marisa Monforte, Pedro de la Iglesia-Martínez, Gemma Jimenez-Guerra, Elena Riera-Pérez, Carmen Collado, Carmen Gallegos, Xavier Mulet, Almudena Fernández-Muñoz, Miquel Àngel Sastre-Femenía, María Antonia Gomis-Font, Laura Zamorano, Antonio Oliver, María Siller-Ruiz, Jorge Calvo, Dolores Quesada, Jun Hao Wang, Cristina Pitart, Francesc Marco, Nuria Prim, Juan Pablo Horcajada, Eduardo Padilla, Ester Del Barrio-Tofiño, Belen Viñado-Pérez, Nieves Larrosa, Fe Tubau, Silvia Capilla, Antonio Casabella, Mar Olga Pérez-Moreno, Emma Padilla, Mónica Ballestero, Alba Rivera, Ferrán Navarro, Fréderic Gómez-Bertomeu, Sergio Pardo-Granell, Ester Picó-Plana, Dolores Guerrero, Carolina Sarvisé-Buil, Alba Belles-Belles, Marta Fernández-Esgueva, María del Pilar Ortega-Lafont, Inmaculada García, Noelia Arenal-Andrés, Susana Hernando-Real, Rosario Ibáñez, Jesús Martínez, Federico Becerra, Carmen Aldea-Mansilla, Asmaa Alaoui-Sosse, José Carlos González, Julia Guzman-Puche, Miguel Ángel Blázquez-Andrada, Nora Mariela Martínez-Ramírez, Alicia Beteta, Bárbara Gomila-Sard, Salvador Giner Almaraz, Eugenio Garduño, Pedro Miguel Juiz-González, Jorge Arca-Suárez, Javier Alba, Pilar Alonso, Ana Isabel Rodríguez, María Isabel Paz-Vidal, Marta García-Campello, Pablo Camacho, María de los Ángeles Pallarés, María Luisa Pérez del Molino, Amparo Coira, Gema Barbeito, Anniris Rincón, Francisco José Vasallo-Vidal, Laura Alonso-Acero, Laura Iglesias-Llorente, Ana Bordes-Benites, Laura Florén-Zabala, José Manuel Azcona, Carla Andrea Alonso, Yolanda Sáenz, Marta Lamata-Subero, David Molina, Ana González-Torralba, Jennifer Villa, Esther Viedma, Emilia Cercenado, Teresa Alarcón, Paula Vargas, María Díez, Rafael Cantón, Patricia Ruiz, María Isabel Sánchez-Romero, Felipe Pérez-García, Genoveva Yagüe-Guirao, Amaia Concepción Oteiza, José Leiva, María Eugenia Portillo, Andrés Canut-Blasco, Matxalen Vidal, Iker Alonso, Maider Zuriarrain, José Luis Barrios-Andrés
Journal: The Lancet Regional Health - Europe (2023)

Pseudomonas aeruginosa healthcare-associated infections are one of the top antimicrobial resistance threats world-wide. In order to analyze the current trends, we performed a Spanish nation-wide high-resolution analysis of the susceptibility profiles, the genomic epidemiology and the resistome of P. aeruginosa over a five-year time lapse.A total of 3.180 nonduplicated P. aeruginosa clinical isolates from two Spanish nation-wide surveys performed in October 2017 and 2022 were analyzed. MICs of 13 antipseudomonals were determined by ISO-EUCAST. Multidrug resistance (MDR)/extensively drug resistance (XDR)/difficult to treat resistance (DTR)/pandrug resistance (PDR) profiles were defined following established criteria. All XDR/DTR isolates were subjected to whole genome sequencing (WGS).A decrease in resistance to all tested antibiotics, including older and newer antimicrobials, was observed in 2022 vs 2017. Likewise, a major reduction of XDR (15.2% vs 5.9%) and DTR (4.2 vs 2.1%) profiles was evidenced, and even more patent among ICU isolates [XDR (26.0% vs 6.0%) and DTR (8.9% vs 2.6%)] (p < 0.001). The prevalence of Extended-spectrum β-lactamase/carbapenemase production was slightly lower in 2022 (2.1%. vs 3.1%, p = 0.064). However, there was a significant increase in the proportion of carbapenemase production among carbapenem-resistant strains (29.4% vs 18.1%, p = 0.0246). While ST175 was still the most frequent clone among XDR, a slight reduction in its prevalence was noted (35.9% vs 45.5%, p = 0.106) as opposed to ST235 which increased significantly (24.3% vs 12.3%, p = 0.0062).While the generalized decrease in P. aeruginosa resistance, linked to a major reduction in the prevalence of XDR strains, is encouraging, the negative counterpart is the increase in the proportion of XDR strains producing carbapenemases, associated to the significant advance of the concerning world-wide disseminated hypervirulent high-risk clone ST235. Continued high-resolution surveillance, integrating phenotypic and genomic data, is necessary for understanding resistance trends and analyzing the impact of national plans on antimicrobial resistance.MSD and the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea-NextGenerationEU.